DESCRIPTION (provided by principal investigator): This country lacks a cohesive, informative surveillance system for vascular disease that can provide insights into national patterns of stroke and reveal national trends over time. Stroke is a major public health problem in the United States. It is the third leading cause of death and a leading cause of serious disability in adults. Its high prevalence and associated deficits impose a large burden on patients, their families, and the health care system. This is especially true among the elderly for whom stroke is a leading cause for hospitalization. Of patients hospitalized with stroke, two-thirds are over age 65;half are over age 70 years. We have assembled an unprecedented national resource by creating a longitudinal Medicare database for fee-for-service (FFS) patients hospitalized with vascular diagnoses over the years 1992-2003, with ability to link additional years of follow-up to the database. Previous studies using Medicare databases have generally employed a cross-sectional approach, not linking, at the patient level, the entire Medicare Part A (hospital admissions) database over time. No other organization or institution has developed such a national database. Our objective is to provide the most comprehensive evaluation of stroke and its outcomes among hospitalized Medicare FFS beneficiaries in the United States. This Competitive Revision Application expands the scope of our current research on stroke surveillance by focusing on incident stroke rates, trends, and outcomes in the elderly, for which we have very little national data. The project leverages the resources, structure, and methodologies established in the current SHEF Study (Parent R01) in which we have examined rates, trends, and outcomes for prevalent ischemic stroke. We recently purchased inpatient data and denominator data for 2004-2006, as well as outpatient and carrier file (physician visit data) for 2005-2006. We plan to link the new data with the existing database. This will provide a 15-year, patient linked data resource that spans from 1992-2006. We will conduct preliminary analyses to describe the utilization of resources (in-hospital, outpatient, and physician services) within the first year following hospital discharge of ischemic stroke. Information on the full burden and cost of stroke is very limited in this population, particularly in terms of how utilization patterns compare for incident or recurrent events, or by the presence of concomitant conditions such as diabetes. Additional resources for this study will accelerate the tempo of this scientific research, allow for job creation of recently trained professionals, provide job retention for current staff, and provide clinical expertise to support this research on national stroke incidence and outcomes in the elderly. Results from the study will provide clinicians, investigators, and policymakers with the best estimates to date of the current burden and national patterns of stroke incidence among the elderly, especially among different subgroups of our population. These results will help inform decisions about the allocation of adequate resources, and more importantly, help identify opportunities to improve care and prevention of elderly stroke patients. PUBLIC HEALTH RELEVANCE: Results from the study will provide clinicians, investigators, and policymakers with the best estimates to date of the current national burden of stroke hospitalizations and outcomes among the elderly, especially among different subgroups of our population. These results will help inform decisions about the allocation of adequate resources, and more importantly, help identify opportunities to improve care and prevention of elderly stroke patients.